Major Depressive Disorder Quiz

Major Depressive Disorder (MDD): Practice Guide for Exam-Style Questions

This guide provides a focused review of the essential concepts related to Major Depressive Disorder (MDD) as defined by the DSM-5. Use this information to sharpen your knowledge for clinical psychology exams and coursework.

Core Diagnostic Criteria (DSM-5)

To secure a diagnosis of MDD, a patient must exhibit at least five of nine specific symptoms for a minimum of two weeks. Critically, one of these symptoms must be either (1) depressed mood or (2) anhedonia (loss of interest or pleasure).

• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in all, or almost all, activities (anhedonia).
• Significant weight loss when not dieting or weight gain, or decrease/increase in appetite.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation observable by others.
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive/inappropriate guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death, suicidal ideation, or a suicide attempt/plan.

Differentiating MDD from Grief

A common clinical challenge is distinguishing MDD from normal bereavement. While both can involve intense sadness, grief is typically tied to a specific loss, with feelings often coming in waves mixed with positive memories. In MDD, the mood is more pervasively negative, and it is often accompanied by persistent feelings of worthlessness and self-loathing that are not characteristic of grief.

Key Specifiers to Memorize

Specifiers provide crucial detail about the presentation of a depressive episode. Questions often test your knowledge of these nuances.

• With Seasonal Pattern: A regular temporal relationship between episode onset and a particular time of year (e.g., fall or winter).
• With Melancholic Features: Severe anhedonia, lack of mood reactivity, early morning awakening, and significant psychomotor changes.
• With Atypical Features: Mood reactivity (mood brightens in response to positive events), significant weight gain, hypersomnia, and leaden paralysis.
• With Psychotic Features: Presence of delusions and/or hallucinations, which can be mood-congruent or mood-incongruent.
• With Anxious Distress: The presence of at least two key anxiety symptoms during the depressive episode.

First-Line Pharmacological Treatments

For most exam questions, Selective Serotonin Reuptake Inhibitors (SSRIs) are the correct answer for first-line medication. They are favored for their efficacy and more tolerable side-effect profile compared to older classes like TCAs or MAOIs. Be prepared to recognize common examples.

Principles of Cognitive-Behavioral Therapy (CBT) for MDD

CBT is a cornerstone of psychotherapy for depression. It operates on the principle that thoughts, feelings, and behaviors are interconnected. The primary focus is on identifying and challenging maladaptive cognitions (e.g., negative automatic thoughts) and changing problematic behaviors (e.g., social withdrawal) to improve mood and functioning.

The Diathesis-Stress Model Explained

This influential model proposes that depression arises from a combination of factors. An individual may have a pre-existing vulnerability (diathesis), such as a genetic predisposition or early life trauma. The disorder is then triggered when this person encounters significant life stress (e.g., job loss, relationship breakdown). Neither factor alone is sufficient.

Recognizing Psychomotor Symptoms

These are observable changes in physical activity. Psychomotor retardation involves a slowing of movement, speech, and thought processes. Conversely, psychomotor agitation presents as restlessness, an inability to sit still, pacing, or hand-wringing. These are not just subjective feelings; they can be seen by a clinician.

Exclusionary Criteria: The Bipolar Rule-Out

As mentioned in the callout, this is a critical point. The DSM-5 explicitly states that the symptoms of a major depressive episode must not be better explained by another disorder, and there has never been a manic or hypomanic episode. This distinction is fundamental to correct diagnosis and treatment planning.

Key Takeaways

• Duration is Key: Symptoms must be present for at least two consecutive weeks.
• Core Symptoms: At least one of the five required symptoms must be depressed mood or anhedonia.
• Grief vs. MDD: Focus on pervasiveness of mood and presence of worthlessness to differentiate.
• First-Line Treatment: SSRIs and evidence-based psychotherapy like CBT are the standard of care.
• The Bipolar Rule: A history of mania or hypomania always points away from an MDD diagnosis.

This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.